Spleen Extracellular Volume Fraction on Computed Tomography as a Noninvasive Predictor of High-Risk Esophageal Varices in Patients with Cirrhosis

Background: Bleeding esophago-gastric junction varices (EGV) represent a life-threatening complication of chronic liver disease. Endoscopic screening remains the standard for variceal risk assessment but is not universally accessible or feasible. The extracellular volume (ECV) fraction derived from contrast-enhanced computed tomography (CT) has demonstrated utility in identifying patients at risk for high-grade EGV and may serve as a predictive imaging biomarker for the high-risk variceal group (HRG). Patients and Methods: This retrospective analysis included patients with cirrhosis who underwent abdominal CT and esophagogastroduodenoscopy between 2019 and 2024 at a tertiary referral center in Tehran. A total of 62 patients (mean age, 50.2 ± 11.5 years; 62.9% male) were evaluated to differentiate between high-risk and non-high-risk variceal group (NHRG). Results: Spleen ECV, CT-based detection of varices, and Child-Pugh score were significantly associated with HRG. A spleen ECV threshold of 38.5 (95% CI, 0.896 - 1.000) demonstrated strong predictive performance. Increased splenic ECV correlated with an elevated risk of HRG. Conclusion: Splenic ECV is a significant noninvasive marker for identifying high-risk esophageal varices in cirrhotic patients. This parameter can be integrated into routine imaging evaluation without additional cost, time, or procedural risk.